Thoracoscopic surgery in childhood cancer

Purpose: Recent advances in minimally invasive surgery, especially thoracoscopy, have allowed many new applications in children. The authors' purpose was in review their experience with thoracoscopic surgery in childhood cancer. They hypothesized that thoracoscopy can be efficacious, safe, and cost-effective and has the potential to change the way we care for children with cancer. Patients and Methods: The authors reviewed their thoracoscopic experience of the past 7 years. Thoracoscopic procedures performed included biopsy and resection of masses, resection of lung nodules, biopsy of infiltrates, and lobectomy. Some resections required conversion to open thoracotomy. Results: Sixty-three thoracoscopic procedures were performed on 52 children; 8 required conversion to open thoracotomy and 55 were completed by thoracoscopy alone. The overall success rate was 98.4%. There were three complications and no deaths. The mean surgery time was 1.2 hours, mean length of hospital stay was 1.9 days, and mean number of chest tube days was 0.7. Conclusions: Thoracoscopic surgery in the treatment of children with cancer can be efficacious, safe, and cost-effective. Mediastinal masses can usually be biopsied and resected by thoracoscopy alone. Conversion to open thoracotomy for a more complete resection can be safely accomplished if needed. Thoracoscopic removal of lung nodules allows more accurate staging and early initiation of chemotherapy. Thoracoscopic biopsy of lung infiltrates can be safely performed in intubated, critically ill children and changed the treatment in all of these patients. Surgery time and days in hospital were decreased compared with historical thoracotomy data.